March 25, 2013 -- Arizona is considering a bill designed to provide more oversight of mobile dental service providers who provide prophys, irreversible procedures, and other dental treatment for children at the kids' schools.

State Rep. Doris Goodale (R-District 5) has introduced HB 2426, which would require double parental notification before a mobile dental unit can provide treatment to children: one for routine cleanings and sealants, and a second for irreversible procedures such as restorations or extractions.

Lee Weinstein, DMD, a Scottsdale pediatric dentist and a member of the Arizona Dental Association who helped write the new legislation, said efforts to increase oversight of mobile dental providers gained momentum following complaints by the parents of Isaac and Joel Gagnon, who received dental treatment at their school in 2011. Four-year-old Isaac was given two pulpotomies and two stainless steel crowns, and his brother Joel received an "excessive" number of x-rays.

The boy's parents say they never approved the procedures, and they subsequently suedBig Smiles, the chain that sends dental teams to schools; ReachOut HealthCare America, the dental service organization that operates Big Smiles; and two dentists who treated the boy, according to a story on azcentral.com.

Since it was founded in 1997, ReachOut has arranged dental care for about 150,000 kids in more than 500 Arizona schools under the brand name Big Smiles.

Dr. Weinstein said he heard complaints about mobile dental services while he was providing free dental care in schools for the state's oral health department.

"We heard all kinds of stories from school nurses regarding these mobile units," he told DrBicuspid.com. "The company says it's their business model. You know what? That patient is not a business."

In 2010, the state's Dental Practice Act was amended to require that parents give written or verbal authorization for specific treatments for their children. But parents were being given a list of all possible procedures that could be done during treatment, explained Kevin Earle, executive director of the Arizona Dental Association.

"Questions were raised about whether it really dealt with a specific treatment for that child," he told DrBicuspid.com.

"Mobile units are just asking for blanket permission, and I have a problem with that," Dr. Weinstein added.

Last year, the Arizona State Board of Dental Examiners proposed Rep. Goodale's bill. It has passed the House of Representatives, but got bogged down in the Senate during negotiations and won't be considered until the next legislative session.

One of the sticking points is avoiding a law that would make it too cumbersome for mobile providers to provide services to children who don't have access to dental care, Earle said.

"We can't have so proscriptive a process that it makes the delivery of care to underserved populations too difficult to provide," he said.

Another consideration is avoiding different standards for private dentists and mobile providers.

"When these services are being done in a remote location from parents, they really need to know exactly what's being done to their children," Earle said.

The best approach, he said, is giving the dental board authority to regulate practices so mobile units can be treated the same way as private dentists.

ReachOut sent this statement to DrBicuspid.com:

ReachOut Healthcare America, on behalf of our affiliated dentists, is working with both the dental board and the state legislature to ensure that rules are in place to require the same consent and standards of care for the children of Arizona in all dental settings, including mobile and fixed office.

Dr. Weinstein said the proposed bill would simply require what private dentists already do now.

"When you bring your kid to me, I walk out and say, 'Is it OK if I do an x-ray or three fillings he needs, or can I take a few minutes to discuss treatment plans?' " he explained. "That's what I do on a daily basis: get dual permission for irreversible procedures. It's a no-brainer. It's no problem to add an extra rule if it's going to protect kids." END

Below are two consent forms sent home with children by ReachOut Healthcare America and their school based mobile dental division.

Whether it’s called Smile (fill in the state) or Big Smiles of (fill in the state) what is important and what they want concealed is evident. In both examples the area on the form where they ask for the child’s Medicaid number is large and black-boxed. What they plan on doing to the child is buried in the fine print. In the Virginia example it states if the parent changes their mind and wishes to not have their child open to any treatment the dentist on site wishes to perform a withdrawal must be made in a “timely” manner or too bad.

Call me crazy- many do - but shouldn’t medical procedures and the consent to perform them be the largest print of all? Fine print is where they stuff companies don’t want you to read are located, right? Guess what ReachOut Healthcare America wants to hide?